Provider Demographics
NPI:1679048508
Name:EVERS, MAKENZIE K
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:K
Last Name:EVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E ALLEGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49070-9758
Mailing Address - Country:US
Mailing Address - Phone:126-935-5271
Mailing Address - Fax:
Practice Address - Street 1:870 E ALLEGAN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:MI
Practice Address - Zip Code:49070-9758
Practice Address - Country:US
Practice Address - Phone:126-935-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer